Pharm final 2 set 1

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Pharm final 2 set 1
2010-05-23 20:52:02
pharm nursing

pharm final 2
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  1. What is the onset for ritalin?
  2. What are the adverse effects for ritalin?
    • Nervousness
    • Insomnia
    • Increased or decreased pulse rate and blood pressure
    • tachycardia
    • loss of appetite
    • nausea
    • abdominal pain
  3. What are the nursing considerations for ritalin (methylphenidate)?
    Arrange to interrupt the drug periodically in children who are receiving the drug for behavioral syndromes.

    Monitor weight CBC and ECG
  4. onset for benadryl (diphenhydramine)
    PO 15-60 min

    IM 20-30 min

    IV Rapid
  5. indications for Benadryl (diphenhydramine)
    • Sleep aid
    • motion sickness
    • allergic rhinitis
    • anaphylaxis
  6. action of Benadryl (diphenhydramine)
    antagonizes the effects of histamine at the H1 receptor sites, does not bind to or inactivate histamine, significant CNS depressant and anticolonergic properties
  7. adverse effects of Benadryl (diphenhydramine)
    • drowsiness
    • anorexia
    • drymouth
    • anticolonergic effects
  8. Nursing considerations for Benadryl (diphenhydramine)
    • assess for urticaria and patency of airway
    • administer 20 meds before bedtime and scheduled activity to minimize interruption of sleep
    • administer at least 30 min and preferably 1-2 hrs before exposure to conditions that may precipitate motion sickness
    • administer w/ meals or milk
  9. indications for Klonopin (clonazepam)
    • seizures
    • panic attacks
    • restless leg syndrome
    • neuralgias
    • acute manic episodes
  10. actions for Klonopin (clonazepam)
    anticonvulsant effects may be due to presynaptic inhibition. Produces sedative effects in the CNS probably by stimulating inhibitory GABA receptors.
  11. onset of Klonopin (clonazepam)
    20-60 min
  12. adverse effects of Klonopin (clonazepam)
    • behavioral changes
    • drowsiness
    • ataxia
  13. nursing considerations for Klonopin (clonazepam)
    assess patient for drowsiness, unsteadiness and clumsiness, these symptoms are dose related and most severe during initial therapy. Administer w/ food, largest dose at bedtime, no alcohol,
  14. onset of Thorazine (chlorpromazine
    15-30 min
  15. Indications for Thorazine (chlorpromazine)
    management of manifestations of psychotic disorders: relief of preoperative restlessness; restlessness; adjunctive treatment of tetanus; acute intermittent porphyria; severe behavioral problems in children; controlled hiccups and nausea and vomitting
  16. actions for Thorazine (chlorpromazine)
    • blocks post-synaptic dopamine receptors in the brain
    • depresses those parts of the brain involved in wakefulness and emesis
    • anticolonergic
    • antihistamine
    • alpha-adrenergic
  17. adverse effects of Thorazine (chlorpromazine)
    • drowsiness
    • insomnia
    • vertigo
    • extra pyrimidal symptoms
    • orthostatic hypotension
    • photophobia
    • blurred vision
    • dry mouth
    • n/v
    • anorexia
    • urinary retention
    • photosensitivity
  18. nursing considerations for Thorazine (chlorpromazine)
    • parenteral forms - keep recumbent for 30 min
    • monitor CBC
    • provide positioning of legs and arms
    • provide sugarless candy and ice chips
    • void before taking a dose
    • vision examinations
  19. onset for librium (chlordiazepoxide)
    • PO 1-2 hrs
    • IM - 15-30 min
    • IV 1-5 min
  20. indications for librium (chlordiazepoxide)
    • anxiety
    • alcohol withdrawal
    • preoperative anxiolytic
  21. actions for librium (chlordiazepoxide)
    depresses the CNS probably by potentiating GABA and inhibitory neurotransmitter
  22. adverse effects for librium (chlordiazepoxide)
    • dizziness
    • drowsiness
    • pain at IM site
    • paradoxical excitation
  23. nursing implications for librium (chlordiazepoxide)
    • parenteral-remain recumbent and observe 3-8 hrs or longer
    • after hrs or w/ milk greater doses at bedtime
  24. classification of cogentin (Benztropine)
  25. onset for cogentin (Benztropine)
    1- hrs
  26. indications for cogentin (Benztropine)
    • parkinsonism
    • drug-induced parkinsonism
    • drug-induced EPS
    • dystonic reactions
  27. actions for cogentin (Benztropine)
    • blocks colonergic activity in the CNS
    • restores natural balance of neurotransmitters in the CNS
  28. adverse effects of cogentin (Benztropine)
    • anticolonergic effects (dry mouth, blurred vision, constipation, paralytic ileus, urinary retention, tachycardia, elevated temperature, decreased sweating)
    • nausea, NGI upset, sedation, dizziness, orthostatic hypotension, exacerbation of psychoses
  29. nursing indications for cogentin (Benztropine)
    • assess parkinsonian NEPS before and throughout therapy
    • assess bowel functions daily
    • administer w/ food or immediately after meals
    • parenteral route is used only for dystonic reactions
  30. classification of Zyprexa (Olanzapine)
    • Therapeutic: antipsychotics, mood stabilizers
    • pharmacologic: thienobenzodiazepines
  31. onset for Zyprexa (Olanzapine)
    • PO unknown
    • IM rapid
  32. indications for Zyprexa (Olanzapine)
    short-term management of acute manic episodes associated with bi-polar disorder
  33. Actions for Zyprexa (Olanzapine)
    • antagonizes dopamine and seratonin type 2 n the CNS
    • anticolonergic and antihistamine and anti alpha-adranergic effects
  34. adverse effects for Zyprexa (Olanzapine)
    • neuroleptic malignant syndrome
    • siezures
    • agitation
    • dizziness
    • headache
    • restlessness
    • sedation
    • weakness
    • amblyopia
    • orthostatic hypotension
    • tachycardia
    • constipation
    • dry mouth
    • weight changes
    • tremor
  35. nursing considerations for Zyprexa (Olanzapine)
    • monitor patient for onset of akathisia (restlessness or desire to keep moving) and EPS (parkinsonian) every two months during therapy and 8-12 wks after therapy has been discontinued
    • monitor for tardive diskinesia (uncontrolled rhythmic movements of mouth, face, and extremities)
    • monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, changes in BP, pallor, tiredness, severe muscle stiffness, loss of bladder control)
  36. Classification of Lithium Carbonate
  37. onset of Lithium Carbonate
    5-7 days
  38. indications for Lithium Carbonate
    treatment of manic episodes of manic-depressive or bipolar illness and for maintenance to prevent or diminish the frequency and intensity of future manic episodes under investigation for treatment of migraines
  39. action for Lithium Carbonate
    alter sodium transport in nerve and muscle cells; inhibits the release of NE and dopamine but not 5HT from stimulated neurons; increases the intraneuronal stores of NE and dopamine slightly;
  40. adverse effects of Lithium Carbonate
    serum levels of <1.5 mEq/L: CNS problems, including lethargy, slurred speech, muscle weakness, fine tremor; polyuria, which relates to renal toxicity and beginning of gastric toxicity w/ n/v and diarrhea

    serum level of 1.5-2mEq/L: intensification of all of the above reactions w/ ECG changes

    serum levels of 2-2.5 mEq/L: progression of CNS effects to ataxia, clonic movements, hyperreflexia and seizures, possible CV effects such as severe ECG changes and hypotension, large output of dilute urine and secondary to renal toxicity, fatalities secondary to pulmonary toxicity

    serum level >2.5 mEq/L: complex multi-organ toxicity
  41. nursing considerations for Lithium Carbonate
    • screen for dehydration and sodium depletion and use of diuretics, protracted sweating or diarrhea
    • w/ food or milk
    • daily monitoring of lithium levels and adequate intake of salt and fluid
    • small, frequent meals
  42. classification of Tegretol (Carbamazepine)
    anti-convulsant, mood stabilizer, PROTOTYPE!!!!
  43. onset of Tegretol (Carbamazepine)
    • PO up to one month
    • PO-ER up to one month
  44. indications for Tegretol (Carbamazepine)
    drug of choice for partial (focal) seizures; tonic-clonic (grand mal) seizures, trigeminal neuralgia; bipolar disorder
  45. actions for Tegretol (Carbamazepine)
    inhibits polysynaptic responses, blocks sodium channels to prevent the formation of repetitive action potentials in the abnormal focus, related to tricyclic antidepressants
  46. adverse effects of Tegretol (Carbamazepine)
    • itaxia
    • drowsiness
    • agranulocytosis
    • aplastic anemia
    • thrombocytopenia
    • hepatitis
    • stephen-johnson's syndrome
  47. nursing considerations for Tegretol (Carbamazepine)
    • w/ food
    • monitor CBC
    • discontinue the drug if skin rash, bone marrow suppression, unusual depression or personality changes occur
    • evaluate therapeutic blood levels
  48. Classification of Nardil (Pheneizine)
    • MAOI
    • PROTOTYPE!!!
  49. Onset of Nardil (Pheneizine)
    2-4 weeks
  50. indications of Nardil (Pheneizine)
    depression in patients who are not responsive to other antidepressant therapy
  51. actions of Nardil (Pheneizine)
    irreversibly inhibits MAO, allowing NE 5HT and dopamine to accumulate in the synaptic cleft
  52. adverse effects of Nardil (Pheneizine)
    • dizziness
    • vertigo
    • headache
    • tremors
    • hyperreflexia
    • mania
    • weakness
    • drowsiness
    • fatigue
    • sweating
    • orthostatic hypotension
    • constipation
    • diarrhea
    • dry mouth
    • edema
    • anorexia
    • hypertensive crisis
  53. Nursing considerations for Nardil (Pheneizine)
    • screen for impaired liver or kidney function, cardiac dysfunction, GI or GU obstruction, surgery, seizure disorders, psychiatric conditions, occurrence of myelography w/in the past 24 hrs or in the next 48 hrs.
    • monitor patient for 2-4 weeks
    • no foods w/ tryamine (aged cheeses or meats, red wines, smoked or pickled meats, avocados, meat extracts, light or pale beer, distilled liquors, chocolate, fruits, sour cream, soy sauce, yogurt)
  54. Classification of Prozac (Fluoxetine)
    • SSRI
    • PROTOTYPE!!!
  55. Onset of Prozac (Fluoxetine)
    1-4 wks
  56. indications of Prozac (Fluoxetine)
    treatment of depression, OCD's, bulimia, PMDD, panic disorders, unlabeled uses include chronic pain, alcoholism, neuropathies, obesity
  57. actions of Prozac (Fluoxetine)
    inhibits CNS neuronal reuptake of 5HT w/ little on NE and little affinity for colonergic histaminic or alpha-adranergic sites
  58. adverse effects of Prozac (Fluoxetine)
    • H/A
    • nervousness
    • insomnia
    • drowsiness
    • anxiety
    • tremor
    • dizziness
    • sweating
    • rash
    • n/v
    • diarrhea
    • dry mouth
    • anorexia
    • sexual dysfunction
    • URI
    • weight loss
    • fever
  59. nursing considerations for Prozac (Fluoxetine)
    • monitor patient up to 4 weeks
    • suggest patient use barrier contraceptives
    • administer 1/day in morning
  60. classification of Elavil (Amitriptyline)
  61. onset of Elavil (Amitriptyline)
    2-3 weeks
  62. indications of Elavil (Amitriptyline)
    • depression
    • unlabeled uses
    • anxiety
    • insomnia
    • chronic pain syndrome
  63. actions of Elavil (Amitriptyline)
    • potentiates effect of 5HT and NE in the CNS
    • has significant anticolonergic properties
  64. adverse effects of Elavil (Amitriptyline)
    • lethargy
    • sedation
    • blurred vision
    • dry eyes
    • dry mouth
    • hypotension
    • constipation
  65. nursing considerations for Elavil (Amitriptyline)
    • ECG monitored before and periodically during
    • drug effects may not be notice for at least two weeks
    • avoid alcohol
    • use suncreen and protective clothing